Ann Rehabil Med.  2011 Jun;35(3):354-360. 10.5535/arm.2011.35.3.354.

Reliability of Visual Classification of Sagittal Gait Patterns in Patients with Bilateral Spastic Cerebral Palsy

• Kim DJ
• Park ES
• Sim EG
• Kim KJ
• Kim YU
• Rha DW

• KMID: 2266854
• DOI: http://doi.org/10.5535/arm.2011.35.3.354

Abstract

OBJECTIVE
To investigate the reliability of inspection-based classification of sagittal gait patterns in children with bilateral spastic cerebral palsy (CP). METHOD: Video clip recordings of gait patterns and sagittal kinematic data obtained by a computerized motion analysis system from 91 patients with bilateral spastic CP were reviewed. The abnormal gait patterns were classified into 4 groups using the method described by Rodda et al. Visual observation-based classification (visual classification) was compared with classification by 3D analysis-based methods (3D classification). The reliabilities of visual classifications made by an experienced physician and a trainee physician were analyzed.
RESULTS
The consistency of inspection-based gait classification using kinematic data analysis was demonstrated by an experienced physician (Kappa coefficient (k)=0.67, p<0.001). However, the consistency was low for the trainee physician (k=0.37, p<0.001). Group III (apparent equinus) was commonly confused with group IV (crouch gait) by the trainee physician, resulting in lower agreement for those two evaluation groups than for other patterns. Video observation showed low reliability in comparisons made between the experienced and the trainee physician (k=0.37, p<0.001).
CONCLUSION
There was substantial agreement of gait classification between video observation and kinematic data analysis by the experienced physician, but not by the trainee physician. Low reliability was also demonstrated for inspection-based gait classification.

Keyword

Spastic diplegia; Gait; Observation; Reliability

MeSH Terms

Cerebral Palsy
Child
Gait
Humans
Muscle Spasticity
Statistics as Topic

Figure

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  Fig. 1 Saggital plane kinematic data for gait patterns. Examples of sagittal plane kinematic data for each gait pattern (Green line for right leg and red line for left leg). Light gray band represents the mean±1 standard deviation of kinematic data from our laboratory's normal database. Vertical axis represents angular displacement of joint and the horizontal axis represents the timeline of single gait cycle. Group 1 (True equinus): The ankle is in equinus. The knee extends fully or goes into mild recurvatum. The hip extends fully and the pelvis is within the normal range or tilted anterior. Group 2 (Jump gait): The ankle is in equinus, particularly in late stance. The knee and hip are excessively flexed in early stance and then extend to a variable degree in late stance, but never reach full extension. The pelvis is either within the normal range or tilted anterior. Group 3 (Apparent equinus): The ankle has a normal range but the knee and hip are excessively flexed throughout stance. The pelvis is normal or tilted anterior. Group 4 (Crouch gait): The ankle is excessively dorsiflexed throughout stance and the knee and hip are excessively flexed. The pelvis is in the normal range or tilted posterior.5

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